摘要
目的观察HBsAg消失后的转归及对乙肝疫苗和乙肝疫苗加免疫激动剂干预免疫的效果。方法连续收集感染HBV后HBsAg消失，以后未出现抗-HBs者97名，年龄18～68（41．9）a，分三组。1组57（22名来自组2对乙肝疫苗无反应者）名，予CHO乙肝疫苗30gg，三角肌内注射，1次／wk，共4针；于同侧近腋皮下注射胸腺因子α1（Tα1）1．6mg，2次／wk，共4wk。2组35名，只接种乙肝疫苗，剂量、方法同1组。3组27名，仅作定期复查。结果末针后1mo五项均阴性、抗-HBe＋和抗-HBc＋、抗-HBc＋者中抗-HBs阳转者组1为12／16（75．0％）、14／19（73．1％）、14／22（63．0％）名，组2仅五项全阴性者中1名（1／10，10．0％），组3无1名，差异显著（P〈0．01）。来自组2的22名抗-HBs阳转率（59．1％）亦高于组2和3（P〈0．01）。随访4．7（2-6）a组1和3抗-HBc消失各1名，平均年消失率为0.3％。平均抗-HBs年阳转率为1．4％。组2、3各有1名出现HBsAg复阳（2．4％）。结论HBsAg消失后年抗-HBs自发性阳转率和抗-HBc消失率很低，甚至有逆转为HBsAg的可能；较大剂量乙肝疫苗加Tα1干预免疫是一有效的方法，对HBV血清学标志物全阴者效果尤佳。
Objective To investigate the prognosis after HBsAg disappearance and the response to recombinant hepatitis B（rHB）vaccine and combined rHB vaccine with thymosinα1 （Tα1）in the population had infected HBV. Methods 97 subjects aged 41.9 （range 18-68） years who had infected HBV and HBsAg disappearance without anti-HBs seroconversion were conscutively collected and divided into three groups. Group A involved 57 cases were vaccined intradeltoideusly with 30μg rHB vaccine once a week and injected subtcutaneously with 1.6 mg Tα1 twice a week, for four weeks. Group B contained 35 cases received rHB vaccine alone as group A.If no response 6 months after last dose,the subjects should be observed as group A.Group C contained 27 cases were regularly tested without any medicine. Results The anti-HBs seroconversion rate in group A,B,C were 70.2% （40/57）, 2.1% （1/35） and 0% （P〈0.001）, respectively.The seroconversion rate of anti-HBs in subjects with all HBV marks negative, anti-HBe and anti-HBc positive, or anti-HBc positive were 75.0% （12/16）, 73.1% （14/19）, 63.0% （14/22） （P〉0.05） in group A and one case （10.0%） with all HBV marks negative in group B, respectively, and was nil in group C （0/27） （P〈0.001）. The seroconversion rate （59.1%） of anti-HBs was also higher in 22 subjects from group B who had have not response to rHB vaccine alone than other subjects in group B and C （P〈0.001）. Mean annual anti-HBc decay rate was 0.3% during 4.7 years following up and mean annual anti-HBs seroconversion rate was 1.4%. HBsAg reversion were 1 case each in group B and C 18 and 36 months after last dose. Conclusions There is very low mean annual anti-HBc decay rate and anti-HBs seroconversion rate after HBsAg disappearance in those who infected HBV, even may reverse to HBsAg again. It is effective for the population to obtain anti-HBs seroconversion within a short time by combined rHB vaccine with Tα1 immunological intervene, especially in those whose HBV marks are fully negative.
出处
《世界感染杂志》
2008年第3期195-198,共4页
World Journal of Infection
关键词
乙型肝炎
乙肝疫苗
HBSAG
乙肝免疫
hepatitis B
hepatitis B vaccine
HBsAg
hepatitis B immunization
